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REPORT OF SURVEY

OF

THE DEPARTMENT OF HEALTH and

CITY OF ATLANTA, GEORGIA

Made for the Atlanta Chamber of Commerce
Committee on Municipal Research

CAT pm ^
mjmQUBiixa

By S. G. LINDHOLM

For the
New York iBureau of Municipal Research

December, 1912

Reprinted for the Training School for public service, conducted by the Bureau of
Municipal Research, 261 Broadway, New York City, Wm. H. Alien. Director

FRANK L. KELLY, M. O.

REPORT OF SURVEY

OF

The Department of Health

City of Atlanta
Georgia

lUf.FOR
FUBUCHEALtH

Made for the Atlanta Cham-
ber of Commerce Committee
on Municipal Research

By S. G. LINDHOLM
For the New York jBureau of Municipal Research .

December, 1912

TCBLIC HEALTH LIB.

PUBUC
HEALTH
ilBRABT

December 19, 1912.

Colonel Frederic J. Paxon,

Chamber of Commerce Committee on
Municipal Research,

57 Whitehall Street, Atlanta, Ga.

Dear Sir:

Herewith please find my report on Atlanta's department of
health. The emphasis upon the record evidence of work under-
taken and work done is due to our conviction based upon ex-
perience that in making a preliminary survey we get our best re-
sults by noting what public departments attempt to do and what
evidence they have of work done and work undone, rather than
by actual field tests.

The report on the health department is presented under the
following headings:

Part I. Efficiency of the health department as revealed by
records.

A. Limitations placed upon the Board of Health by city code
and ordinances that detract from its efficiency.

B. The use made of the powers given by the code to the
health department.

Part n. Method and procedure of the health control.

Part HI. Inspection of certain dwelling houses.

Part IV. Recommendations.

Very truly yours,

BUREAU OF MUNICIPAL RESEARCH.

Per S. G. Lindholm.

M'?98331

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in 2008 with funding from

IVIicrosoft Corporation

http://www.archive.org/details/atlantahealthsurOOburerich

L

EFFICIENCY OF THE HEALTH DEPARTMENT AS RE-

VEALED BY RECORDS.

In measuring the efficiency of the health department of At-
lanta, two factors must be considered:

A. The limitations placed upon the board of health by the
city code and ordinances that detract from its efficiency.

B. The use made of the powers given by the code to the health
department.

A. Limitations placed upon the board of health by the city code
and ordinances that detract from its efficiency.

1. The method of ward election — ten members, one from each
ward plus three ex-officio members — ^prevents men of re-
quired skill and experience to serve upon the board because
they do not happen to live within the ward.

2. Wards must elect men that are incompetent to deal with
technical problems because of this limitation as to residence.

3. The ward method of electing members both to the board of
health and to the general council almost inevitably means
that each ward member in the general council selects the
board of health member from his own ward thus introduc-
ing the element of politics in an election that should be gov-
erned solely by consideration of expertness.

4. Professional qualifications are not demanded in any mem-
ber of the board.

5. The size of the board — two ex-officio and ten ward mem-
bers— must make it cumbersome in dealing with health
problems where quick decisions are frequently necessary.

6. The power of the general council to set aside health ordi-
nances must inevitably take the spirit out of the health
board in enforcing any ordinance that is likely to interfere
with private interests.

7. The failure to vest in the health department the power to
adopt and give legal sanction to health ordinances bars the
health board from formulating and executing a policy by
which public health shall be guarded against private inter-
ests.

8. The power to create a sanitary code is usually a charter
right of the health departments in modern cities. See, for
instance, section 1172, New York City charter.

9. The method of election, therefore, makes it unreasonable
to demand that the board of health in Atlanta should pos-
sess such qualifications for dealing with health problems as
are now demanded from health departments in well admin-
istered cities.

10. The power of the general council to refuse to enact health
ordinances demanded by the board of health and its power
to set aside ordinances at the importuning of private
interests must make the administration of the board
halting and vacillating.

B. The use made of the powers given by the code to the health
department.

1. Weaknesses inherent in present executive organization of
department.

a. There is no single executive head.

b. The health officer and the chief sanitary inspector are
not only independent of each other but

c. Are responsible to an inexpert board.

d. Thus unity of purpose or action can not be insured, for
harmonious personal relations such as seem to exist can
not take the place of the right system.

2. Points of efficiency noted in the administrative organiza-
tion of department.

a. The health officer showed familiarity with modern
methods of dealing with infectious diseases.

b. The sanatorium for tuberculosis patients is erected upon
grounds admirably chosen and with buildings and pa-
vilions that seem to combine adequacy with wise economy
in construction.

c. A creditable system of milk inspection, both of country
dairies and of city distribution, including use of score
cards, was outlined to the investigator.

d. The campaign to exterminate mosquitoes deserves much
more than the support it receives from the city.

e. The bacteriological laboratory serves as a nerve centre
for the health work of the whole city.

f. The embryo tuberculosis exhibit at the entrance to the
city hall shows what the department would and could do
if Atlanta were to finance and organize it adequately.

g. This list does not exhaust the commendable features
seen by the investigator. The testimony is freely offered

that great credit must be given for work accomplished
by the present health officer and to his chief adviser, the
city bacteriologist. It was evident that they and their
staff had striven to do their best with the limitations un-
der which they were working. To many of the defects of
the department the health officer himself called attention.
In calling attention to defects that impressed the investi-
gator it is therefore not necessary to apportion here the
responsibility between the city, the board or the executive
officers.

3. Points of weakness noted in administration of department.

a. The staff is not adequately supervised.

(1) The inspectors of the department do not render ade-
quate reports of hours spent on duty, action taken at
each inspection, conditions found in stores, markets,
etc., inspected.

(2) The notebook carried in the pocket of the inspector
from which bi-weekly summaries are submitted to the
board does not place before the health officer all the in-
formation concerning any one place inspected. No evi-
dence was found that these note-books were inspected
regularly by the health officer.

(3) Lacking definite information of the methods by which
the inspectors perform their duties the health officer is
not in a position to insure that these methods are the
most adequate.

(4) Lacking definite records of the sanitary conditions of
places inspected the health officer must rely upon per-
sonal reinspectcion or general statements from his in-
spectors to know whether conditions are improving or
his policy of inspection is adequate to cope with the
situation.

(5) Through the lack of time reports from its inspectors
the department is liable to loss through misdirected or
delinquent service.

b. Health conditions are not adequately supervised.

(1) Adequate information as to the existence and spread
of communicable diseases is not obtained in the health
office.

(2) The physicians are not made to live up to their duty
of reporting contagious diseases. Whatever policy the
health department may adopt in regard to the control
of infection it disregards both city ordinances and the
f undamenal rule of health control as long as it permits
laxity in the reporting of infectious diseases.

8

(3) The department does not demand nor obtain informa-
tion as to the probable cause of infection. Its records
tell only the name, address and character of disease
of the infectious case.

(4) The department provides hospital facilities only for
smallpox, scarlet fever and diphtheria and in case of
the last two infections, for white people only.

(5) Cases of measles that can not be isolated in their
homes, as those found in living rooms connected with
stores, workrooms, etc., must remain a public menace.

(6) All cases of infection, smallpox possibly excepted,
among colored people are allowed to spread the disease
broadcast without any effective interference.

(7) The department has not taken steps to secure an ade-
quate register of tubercular cases in the city.

(8) Of cases that have come to the notice of the depart-
ment it does not secure and keep for ready reference
such information as is deemed necessary by cities which
are attempting to control this disease.

(9) The department does not keep records of complaints
made by citizens, to what inspector the complaints were
referred, what was found upon investigation and what
was done by the inspector in regard to the complaints.

(10) By destroying the record of the original complaint
the health officer puts it beyond his power to trace the
action taken or the need for action. The New York
City charter recognizes the importance of this citizen
co-operation by demanding that all complaints shall be
entered in a book. The inspection of this book is one
of the important means by which the informed citizen
can gauge the efficiency of the health control.

(11) The records of inspection of markets, slaughter
houses, milk depots and other places are not filed so as
to collect all information in one place.

(12) Lack of follow-up work in cases needing supervision
robs inspection of much of its results. The card, re-
porting the scoring of country dairies, is filed away, no
notice or warning being sent when the department finds
that the scoring is low or conditions bad.

(13) These score cards are filled chronologically so that
the health officer, in looking at one card, can not tell
without a long hunt whether the conditions of the dairy
had improved or grown worse since the last inspection.

(14) The department keep no records whatever of sani-
tary conditions in dwelling houses.

II.

METHOD AND PROCEDURE OF HEALTH CONTROL.

Control of Communicable Diseases.

All physicians are required to register with the department.
Permits to practice medicine in the city are issued by the state
board of medical examiners. There are three bodies of physi-
cians recognized — homeopaths, allopaths and eclectics. Under
the last group many candidates are passed by the examiners
who would be considered incompetent by regular practitioners.

Midwives charging a fee, are also required to register, but
the board makes no attempt to supervise their practice, or even
to ascertain the total number in existence.

Reporting upon cases of communicable diseases is required by
the code, but no efforts are made by the board or the health offi-
cer to enforce this ordinance. The reports made come voluntarily
from the physicians who, it is said, frequently consult the wishes
of the family in regard to reporting. The department is, there-
fore, most inadequately informed as to the existence of conta-
gious diseases. The code defines as contagious or infectious the
following: Smallpox, cholera, diphtheria, membranous croup,
measles, typhoid fever, typhus fever, scarlet fever, yellow fever,
and such other diseases as may be publicly declared by the board
of health to be contagious or infectious. Among the latter,
tuberculosis has recently been included.

Cases of scarlet fever, diphtheria and smallpox are quarantined
by the department. Quarantine is established and a placard
posted upon the report of a physician, or in the case of diphtheria
cases upon the positive culture by a bacteriologist. The method
of isolation is lenient. In case of diphtheria the nurse and pa-
tient are expected to stay in isolation while the rest of the family
may continue their usual occupations, provided that they do not
enter the sick room. School teachers living in a placarded house
are not permitted to continue teaching. In the case of smallpox
all members of the family were formerly taken to the quarantine
hospital, but now only the patient is removed to the hospital.
The members of the family and others having visited the family
are vaccinated. No other compulsory measures are taken. The
ordinance requires that all grown persons in the city shall be
vaccinated and the health officer is given power to enforce this
ordinance. He said that every eight or ten years a general vac-
cination of all cities is made. At the last general vaccination,
forty physicians being employed by the city for this purpose.

10

worked four hours a day until the city has been covered. A pub-
lic announcement is first made that all people must be vaccinated
within 24 hours, after which time any having neglected it, may
be forced to be vaccinated. The vaccine is bought from private
laboratories. No attempts have been made by the department to
manufacture its own vaccine.

Reports of contagious cases are sent by the health officer to
the secretary of the school board, to the Carnegie Library and
the private schools. Fumigation is performed by the department
on the day requested by the attending physician, or upon the ad-
vice of the chief medical inspector.

The placarding of houses and the performance of fumigation
is made by the two medical inspectors. Neither of these is a
physician, but one of them, according to the health officer, has
gained through long practice, great efficiency in the diagnosis of
smallpox.

The records of work performed is kept in a notebook continu-
ously carried by both, of which a bi-weekly summary is presented
to the board of health. The record of each case is also kept in a
card file. Each record contains the following information — street
address, date of report, name of patient, name of physician re-
porting the case. Records of fumigation are kept in a journal
containing the following headings : date case is reported, name of
patient, address reported, date of fumigation, removed to hos-
pital, color (white or colored), by whom reported, name of the
disease.

It is, therefore, apparent that the records of contagious cases
serve only the purpose of supervising individual cases. No rec-
ords are obtained indicating the possible source of contagion or
any clinical data as are usually obtained by health officers for the
study of the spread and control of infection. It is also apparent
that such a half-hearted dealing with contagion is of practically
no value to the city. The placard as a warning to unnecessary
visitors is valuable.

It did not appear that the patient or his caretaker were given
any instruction in the proper care or methods by which other
people may be safeguarded or the patient profited, aside from the
injunction that the patient and his nurse should be isolated. Such
injunction is usually of no direct value, as the department does
not inform itself by frequent reinspections whether such injunc-
tion is being enforced.

Medical Attention of Indigent Sick.

Two physicians are engaged on full time to care for the poor
of the city. To them are referred all charity cases requiring
medical attention. When not visiting in the homes they may be
found in the office of the health department. They are also re-
quired to vaccinate children who apply for this purpose at the

FRANK L, KELLY, M. 0.

11

health office. The records of the visits of the city physicians are
kept on cards — one card being made out for each patient. The
records are kept as follows: Name, color, address of patient,
the dates when the visits were made and remarks as to diagnosis
and history of the case, a monthly summary of the number of
visits made. One city physician said that he averaged 350 visits
a month. Aside from a monthly summary of these cards which
is submitted to the board, no evidence could be found of any
supervision of the work of these physicians. It was left to the
judgment and conscience of the physicians to perform their work
efficiently.

If drugs are required in treating a patient a prescription is
left by the city physician at certain drug stores, who have con-
tracts with the city to furnish these drugs. Bills for the filling
of prescriptions are submitted by these druggists to the health
officer, who 0. K.*s them and issues the necessary warrants for
their payment.

Food Inspection. ^

The health officer stated that there are about 300 markets in
the city. The records of the two inspectors of these markets are
kept in notebooks by the inspectors. No effort is made to collect
the information on conditions found and inspection of the in-
dividual markets. To obtain, therefore, the history of the con-
ditions of any one market, it would be necessary to collect such
information from the various notebooks of the inspectors.

It does not appear in what manner the chief officer can obtain
definite information as to the conditions of these markets or of
the efficiency of the inspectors, except by asking direct questions
from the inspectors or from hearsay evidence. That he can say
whether the sanitary conditions of the meat markets are improv-
ing or whether food is sold under conditions that meet with the
requirements of the city ordinances, not to say with the require-
ments of a careful consumer, does not appear self-evident to the
investigator. It is certain that he can not convince any inquiring
citizen or an intelligent health board that the department is doing
all it can with its resources, or that the general council has made
such provisions for the inspection of markets as necessity re-
quires.

There are three slaughter houses in the city and all meat
slaughtered is required to be inspected before killing. To open
a slaughter house a permit is necessary and the consent of the
surrounding property owners is required before the permit is is-
sued. The health officer said that all small slaughtering pens
have been abolished ; that these three abattoirs are in a sanitary
condition and that all meat is inspected and stamped by the in-
spectors. Asked whether the records of these abattoirs were in-
spected by himself or whether he had any evidence that con-

12

demned meat was actually withdrawn from the market and de-
stroyed as food, he could only refer to the regulations as to the
handling of these products.

Reminded that the experience of all cities demonstrates that
these inspectors are continually surrounded by temptations to
let up on the inspection and even to pass tainted meat and that
the most vigorous supervision of the superior officer is necessary
to aid the inspectors in resisting these temptations, he admitted
that he did not render such aid.

Milk Inspection.

Two country milk inspectors are traveling from dairy to dairy,
scoring conditions found in the dairies on a score card, adapted
with slight modifications from the United States score card.
These score cards are mailed to the central office where they are
filed chronologically. No evidence was found that the central
office followed up the information thus obtained from the country
milk inspectors, either by writing a letter to the dairyman, point-
ing out if the score card indicated such a need, the defects re-
ported or demonstrating to the dairyman that the health depart-
ment was watching conditions under which milk was produced.
The only value of this inspection, therefore, is the contact be-
tween the inspector and the dairyman and such advice as the in-
spector may offer; that such advice has been given is not re-
ported, although it may be assumed that the interest of the in-
spector causes him to give it.

There was no evidence that the information obtained as to the
condition of the dairy was correlated to the conditions in city
milk depots or wagons distributing milk from this dairy. The ad-
vantage that might be obtained by this power to supervise the
distribution of milk and the sources of protection is, therefore in
a measure, lost. The efficiency of milk inspection depends now
altogether upon the conscientiousness of the inspector ; the health
officer might, therefore, be almost entirely eliminated as a factor
in the health supervision.

Nuisances.

Complaints coming from citizens are received over the tele-
phone or otherwise and recorded by the receiving clerk on a slip
of paper. These slips are distributed to the inspectors of the dis-
tricts from which the complaint was entered. After the com-
plaint has been referred to the inspector these records are de-
stroyed. No records, therefore, of complaints are kept except
the notation in the note-book of the inspector of what he did.
Whether there was a just cause of complaint or this cause was
removed as a result of the inspector's visit, or whether the in-
spector visited at all, is not reported to the chief health officer.

The method of communicating with the inspectors is as fol-

13

lows : On a board in front of the clerk are rows of hooks, each
hook being labeled with the number of the ward, and also hooks
for the reports on contagious diseases, fumigations, etc. The
slips of paper on which the complaints are recorded are then
fixed to the hook of the ward from which the complaint came.
Each inspector is supposed to communicate with the office twice
in the morning and twice in the afternoon and to him are then
referred whatever cases there are in his ward. After this noti-
fication the slip containing the record is destroyed.

The code provides in paragraph 821 that the chief of con-
struction shall keep a complaint book wherein the police sani-
tary inspectors or any citizen may make entries of obstacles or
defects in the streets and the sewers. The code makes no pro-
vision, as is customarily done in cities, for the preservation of
the records of complaints made to the health department.

Issuance of Plumbing Certificates.

The code requires that permits for the proper installation of
plumbing in new buildings and in alterations of old buildings
must be issued by the board of health.

Requests for such permits come from the plumber with the
blue prints of the plans. The plumbing plans are then passed
upon by the plumbing inspector. After the plumbing has been
installed a notice is sent by the plumber of the date when it is
ready for inspection and testing. The plumbing inspector re-
ports upon the conditions found and the test made after which
a permit signed by the health officer is issued. Upon the is-
suance of this permit the board of water works is supposed to
make the water connection.

A most cursory inspection of these records shows evident lack
of proper supervision by the health department and proper co-
ordination with other departments. No evidence was seep that
the water board, for instance, must wait for the plumbing per-
mit before it makes the connection with the water meter and
issues its water permit. Upon inquiring of the plumbing in-
spector whether he was sure that such connection was not made
before the issuance of the proper plumbing permit, or even
without inspection having taken place, the investigator was in-
formed that no such check was made by the health department
and that, in fact, he believed that in many cases the water board
would make the meter connection without the proper plumbing
permit.

The plumbing inspectors do not render a daily account of the
amount of work done. The only way to find the amount of
work done is by counting the number of slips that have been
returned by the inspectors, as inspected during the day, which
procedure is not customary ; or from the monthly statistical re-
port submitted by each inspector to the board.

14

The Laboratory.

Dr. Smith, the bacteriologist, makes all the examinations of
specimens submitted by physicians or the department inspectors
in cases of actual or suspected contagion. He examines all
diphtheria cultures and reports to the attending physician. He
also examines sputum for the presence of tuberculosis. He
makes chemical examination of milk for fat and solid contents
and for the presence of dirt, pus and other adulterants. Bac-
terial counts of milk are also made. Upon request he examines
specimens of blood in cases of suspected typhoid. Tests of the
purity of water are occasionally made.

Under Dr. Smith's jurisdiction a campaign to exterminate
mosquitoes was started in 1903 when an appropriation was made
for it. After a few years of successful work a new general
council, not understanding its value, cut the appropriation. In
1905, however, the importunities of many intelligent people
caused the restoration of part of the appropriation which has
been continued ever since. Most of this work is done during
the summer when several men are hired, although they have no
expert knowledge of the mosquito, to go around and inspect
premises and to instruct tenants in methods of destruction.

Vital Statistics.

It is the duty of the health officer to report to the board all
statistics relating to births and deaths. The reporting of births
is most incomplete; fewer births than deaths of infants under
one year being reported. Birth certificates are not required
at the entrance of a child in school. The health officer did not
know whether the law demanded a birth certificate as evidence
of age when a working certificate was issued to a child; in fact,
he was not sure whether an age limit was required of children
entering upon profitable employment. As a result no official
records of births are accumulated.

The state law does not require the issuance of birth or death
certificates. Asked whether the records of the cemetery were
ever inspected by the health department to ascertain whether
the law as to burial permits was lived up to, the health officer
said that this was not done.

Death certificates were issued in the form prescribed by the
United States health bureau. These certificates are copied on
special cards which are filed chronologically. These cards were
tabulated in the manner required by the census bureau.

As to the correctness of the cause of death, stated by the
physician, the health officer had a great deal of doubt, but he
was compelled to accept the physicians* reports as final.

15

III.
INSPECTION OF CERTAIN DWELLING HOUSES.

The first row of houses visited was No. 176 to 182 Forsyth
Street. The basement rooms of these negro quarters were in-
spected. The houses are of brick, two stories and basement.
The approach to the first floor from the street forms an arch
over the basement windows. In the alley underneath, ashes,
dirt and refuse had been thrown. Only half daylight could pen-
etrate to the front basement windows.

A hallway, about three feet wide, extended through the base-
ment from the front to the rear. This hallway was absolutely
dark, it being impossible to see six inches in front of one's self
after having taken three steps from the front door. This hall-
way was broken in the middle into an angle where it allowed, on
the right side, a room with the door in the hallway and a window
in the rear, which window, in its turn, looked into a shed ex-
tending from the rear wall of the house.

On the left of the hallway were two rooms, the front room
having two windows opening on the half-enclosed alley above
mentioned; and the rear room, serving as a kitchen, opening
through a door into the yard, and having one window in the
rear. The floors of the kitchens, in all of the four houses were
flush with the yard permitting the water in the yard to flow
into the kitchen. In one of the kitchens, in order to drain this
inflow of yard water, a board has been removed from the floor.
Looking through this opening one could plainly see the stagnant
water accumulated underneath the floor.

In the shed, previously mentioned into which the only window
of the room to the right opened, ashes and charcoal underneath
a kettle or boiler on the dirt floor showed its use as a laundry.
There was no gas in the hallway or basement.

The water supply for the people in the house was taken from
a hydrant in the front yard. The waterclosets were in the rear,
and connected with sewers. The collection of garbage was also
made from the alley in the rear. Both in the front and back
yards ashes, garbage and remnants of food were scattered all
over the ground. The rentals for these rooms were said to be
$4.00 a month for the front room and $3.00 a month for the
kitchen. The single rooms to the right of the halls were locked,
and no information could be obtained concerning them.

No. 24 Peters Street.

The second floor of this house was visited. The first floor was

16

a wagon repair shop. This house had been a frame building,
but the greater part of the clapboards and plastering had fallen
down, leaving large openings both in the outside walls and in
the partitions.

The living rooms opened into a central hallway, and several
white people were found as lodgers. Water was admitted
through a pipe running alongside the rear porch, ending in a
faucet, from which the drippings were drained into a cup-shaped
outlet. The closets were on the rear yard. The rooms rent for
$3.00 or $4.00 a month each.

No. 349 1-2 Peters Street.

The upper floor of this house served as a lodging house for
white people. Entrance was obtained from the rear porch to
two hallways, which divided the floor into three sections. The
light to the two outside sections was received through windows
in the walls and to the middle section through a skylight. All
walls were dilapidated, the plastering falling down. Water was
obtained on the rear porch from three hydrants, one for each
section. The watercloset was in the yard, and connecting with
sewers. These rooms averaged $2.00 a month each. The name
of the owner or landlord was shown on a placard on the street
door.

No. 267 1-2 Peters Street.

The upper floor was inhabited by white people. The hallway,
forming an "H," divided the floor in a number of two-room
apartments, those fronting the street on one side of the middle
bar of the "H," having one room with a window opening into
the street, and one dark room between the front room and the
hallway. Across the hall the two rooms were arranged along-
side of each other, both opening into the yard. The rooms on
the side bars of the "H** had windows opening to an airshaft
about three inches wide, the other side of this airshaft being the
brick wall of the adjacent house.

The water was obtained from the apartment in the center of
the house, where a hydrant and sink were built next to the
watercloset. The apartment containing this sink and water-
closet was not occupied. The walls consisted of one-inch boards.
Tenants complained, with abundance of evidence as to their
truthfulness, that the roofs leaked, and that the floors were
falling to pieces. In none of the houses seen was there a care-
taker, or janitor, to see that proper cleanliness or decency was
observed.

Negro Section Surrounding Lowe Alley.

Here a tract of land, perhaps two acres in extent, is covered
by one and two room negro shanties. The light and ventilation

17

in these shanties are obtained principally through the door. A
brick chimney runs through the center of the two-story shan-
ties, with an open hearth serving as fireplace and cooking stove.
In one of the rooms of the first shanty seen there was an old
negro sitting before the fireplace, kneading with his hands the
dough for cakes which he was evidently frying in a pan in the
open fireplace. He had lost one leg. Asked what he did for a
living, he said that he had two renters — one of these had a bed
of his own and paid him twenty-five cents a week, the other,
sharing his own bed, paid him fifty cents a week. These two
beds and the chair on which the "darky" was sitting, constituted
the chief furniture.

All of these shanties were raised from one to two feet from
the ground. The waterclosets were surface privies with no
water, presenting on the inside every stage of conceivable filth.
The cans had evidently been emptied within a day or two.

Garbage was scattered in all kinds of receptacles, as well as
promiscuously on the ground. As the cans could not come
within three inches of the seat, no protection from flies or in-
sects could be provided.

The water supply was obtained either by walking to Peters
Street or from a number of wells within the district. Two of
these wells were examined. In one of them the brick lining
stopped about ten feet from the top of the ground, in the other
about four feet. The only protection against surface water run-
ning into these wells were loose boards and a slight embankment
of dirt against these walls.

If the water from these wells were not used for drinking pur-
poses, it certainly must have been used for the washing of
clothes, which seemed to be the chief industry of the neighbor-
hood. These conditions suggest that it would be most desir-
able to have an investigation made as to the quantity of soiled
clothes collected into this and similar places, the surroundings
in which they are washed, the water used in washing them, the
places where they are dried, the method of ironing, the manner
of storing these clothes — both before washing and after they
have been washed — previous to leaving these shanties for de-
livery to the owners.

It would also be desirable to investigate the number of vari-
ous houses in the city to which the inhabitants of this section
go for work during the day. It would be eminently desirable
to make a careful study of the methods by which such diseases
as are almost inevitable concomitants of these housing condi-
tions, are prevented from spreading to the people who receive
laundry, or in whose homes the inhabitants of this section per-
form service.

In this whole section there is not one bath tub. There is no
attempt at street lighting. The playground of the children is

18

the mud. There is one church — the Warren Methodist — offer-
ing as a gathering place its single room auditorium.

On the edge of this district is a row of two-story frame
houses, starting with No. 20 Leonard Street. These are in-
habited by white people. Each floor consists of a row of three
rooms, renting for $6.30 a month. There is a hydrant on each
floor, with a closet in the yard connecting with sewers. The
dilapidated condition, tfle filth, the stagnant water — both from
the front and rear yards in which the children play — seem to de-
mand a careful inspection.

Three negro lodging houses were inspected. The first, 12 1-2
Ivy Street, occupied the two upper floors of the "Great North-
ern Hotel." Each room in this lodging house had a window
opening either on the street, or on the rear yard. The rooms
contained from two to five beds each. The toilet facilities for
the two floors consisted of a single sink and watercloset, to
which the men and women lodgers admitted to these premises,
were compelled to resort. The hallway was lighted by a gas
jet.

The second lodging house was 3 1-2 Ivy Street, covering one
floor. Here also one watercloset was found with one sink. This
lodging house also admitted both men and women lodgers, at
payment of 25 cents a night. The caretaker had to hunt for a
kerosene lamp to light the hall, as well as the rooms, explaining
that the gas meter was out of order, and had been so for over a
month. Probably the non-payment of the gas bill caused this
disorder. The watercloset was extremely dirty.

The third lodging house, only a short distance from this last,
also occupied one floor. The hallway, running through the
length of the floor, gave access to four rooms on either side. The
two central rooms had no windows, only the outside rooms hav-
ing a window each, opening on the street or the yard in the
rear. Only kerosene lamps were provided. The shouting of
women and crying of infants greeted the visitors.

It requires no imagination to conceive what must take place
in a lodging house where the halls are pitch black, rooms have
no ventilation or privacy, the single toilet facility which also
serves as the washroom and source of drinking water must be
shared by all of the lodgers where the sexes are herded promis-
cuously, and even the most elementary observance of cleanli-
ness, either of bed clothes or floors and walls are not observed.
The oil lamp in such places as these must show its effect on the
insurance rates of the district.

19

IV.
RECOMMENDATIONS.

It is recommended

1. That the making of health ordinances or the sanitary code
be the function of the board of health and that no other
body have the power to repeal the same as long as they
conform to existing laws.

2. That the administrative functions under the board of
health be placed under the direction of one head who shall
be held responsible for their performance, 1. e.

8. That heads of divisions within the department, as the
offices of health inspection, sanitary inspection, plumbing
inspection, the city physicians, etc., be responsible to the
departmental head.

4. That all inspectors be required to render daily reports of
work done and time consumed.

5. That the system of record keeping be reorganized.

6. That the letter of the law relating to the reporting of con-
tagious diseases be enforced.

7. That in demanding these reports the department also de-
mand or by direct inspection ascertain such information as
will enable it to take measures for checking and if possible
eliminating contagion.

8. That the department establish reasonable control of the
practice of midwifery and urge upon the city to provide
training schools for midwives.

9. That in case of deaths of infants whose births have not
been reported, the department inquire as to whose fault,
if anyone's, the neglect of reporting was due.

10. That a tuberculosis register be established, containing
such information of the patient's history, family and hous-
ing conditions as will help the department to take intelli-
gent measures in checking the communication of the dis-
ease to others.

11. That the department recognizes the value of citizen co-
operation in complaints made of unsanitary conditions;
that permanent records be made of each complaint, its in-
spection and final disposition.

20

12. That the department publicly report the findings, both of
fat contents and of bacterial count of milk and the names
of the dealers in milk in the city and that a sufficient num-
ber of tests be made that such reports may be made monthly.

13. That the present inspectors be detailed, as far as other
duties will permit, to the inspection of so-called "lodging
houses" and that the department report speedily to the
board and the general council on such fundamental sanitary
conditions as ventilation, ratio of water closets to number
of lodgers, use of the same water closets by both sexes,
lavatories, general cleanliness and fire danger.

14. That the department formulate a plan and submit to the
general council a request for an appropriation for the in-
spection of housing conditions.

15. That the penalties for committing smoke nuisances be
strictly enforced against office buildings and factories.

16. That the board of health secure from the general council
action which will define clearly under whose authority the
sanitary policing of the watershed shall be undertaken, and
that proper supervision of the watershed be at once estab-
lished. The principles which actuate the general council
to invest city money in a water purification plant and allow
surface privies to exist in the closest proximity to the puri-
fication plant are more than incomprehensible.

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